Manic-depressive syndrome (disorder): causes, signs, diagnosis, how to treat. Manic psychosis: what it is, signs and methods of treatment Manic depressive psychosis manifestation

Manic-depressive psychosis (MDP) refers to severe mental illness that occurs with a succession of two phases of the disease - manic and depressive. Between them there is a period of mental "normality" (light interval).

Table of contents:

Causes of manic-depressive psychosis

The onset of the development of the disease can be traced most often at the age of 25-30 years. Relative to common mental illnesses, the level of MDP is about 10-15%. There are 0.7 to 0.86 cases of the disease per 1000 population. Among women, pathology occurs 2-3 times more often than in males.

Note:the causes of manic-depressive psychosis are still under study. A clear pattern of transmission of the disease by inheritance was noted.

The period of pronounced clinical manifestations of pathology is preceded by personality traits - cyclothymic accentuations. Suspiciousness, anxiety, stress and a number of diseases (infectious, internal) can serve as a trigger for the development of symptoms and complaints of manic-depressive psychosis.

The mechanism of the development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex, as well as problems in the structures of the thalamic formations of the brain. The dysregulation of norepinephrine-serotonin reactions, caused by a deficiency of these substances, plays a role.

V.P. Protopopov.

How does manic-depressive psychosis manifest?

Symptoms of manic-depressive psychosis depend on the phase of the disease. The disease can manifest itself in a manic and depressive form.

The manic phase can proceed in the classic version and with some features.

In the most typical cases, it is accompanied by the following symptoms:

inadequately joyful, exalted and improved mood;
sharply accelerated, unproductive thinking;
inadequate behavior, activity, mobility, manifestations of motor excitation.

The beginning of this phase in manic-depressive psychosis looks like a normal burst of energy. Patients are active, talk a lot, try to take on many things at the same time. Their mood is upbeat, overly optimistic. Memory sharpens. Patients talk and remember a lot. In all the events that take place, they see an exceptional positive, even where there is none.

Excitation gradually increases. The time allotted for sleep decreases, patients do not feel tired.

Gradually, thinking becomes superficial, people suffering from psychosis cannot focus their attention on the main thing, they are constantly distracted, jumping from topic to topic. In their conversation, unfinished sentences and phrases are noted - "language is ahead of thoughts." Patients have to constantly return to the unsaid topic.

The patients' faces turn pink, facial expressions are overly lively, active hand gestures are observed. There is laughter, increased and inadequate playfulness, those suffering from manic-depressive psychosis talk loudly, scream, breathe noisily.

The activity is unproductive. Patients simultaneously "grab" a large number of cases, but none of them is brought to a natural end, they are constantly distracted. Hypermobility is often combined with singing, dancing, jumping.

In this phase of manic-depressive psychosis, patients seek active communication, intervene in all matters, give advice and teach others, and criticize. They show a pronounced reassessment of their skills, knowledge and capabilities, which are sometimes completely absent. At the same time, self-criticism is sharply reduced.

Increased sexual and food instincts. Patients constantly want to eat, sexual motives clearly appear in their behavior. Against this background, they easily and naturally make a lot of acquaintances. Women are beginning to use a lot of cosmetics to attract attention to themselves.

In some atypical cases, the manic phase of psychosis occurs with:

unproductive mania- in which there are no active actions and thinking is not accelerated;
solar mania– behavior is dominated by an overjoyful mood;
angry mania- anger, irritability, dissatisfaction with others come to the fore;
manic stupor- manifestation of fun, accelerated thinking is combined with motor passivity.

In the depressive phase, there are three main signs:

painfully depressed mood;
sharply slowed down pace of thinking;
motor retardation up to complete immobilization.

The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbance, frequent nocturnal awakenings, and the inability to fall asleep. Appetite gradually decreases, a state of weakness develops, constipation, pain in the chest appear. The mood is constantly depressed, the face of patients is apathetic, sad. The depression is on the rise. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-accusation, patients try to hide in inaccessible places, experience painful experiences. The pace of thinking slows down sharply, the range of interests narrows, symptoms of “mental chewing gum” appear, patients repeat the same ideas, in which self-deprecating thoughts stand out. Suffering from manic-depressive psychosis, they begin to remember all their actions and give them ideas of inferiority. Some consider themselves unworthy of food, sleep, respect. It seems to them that doctors are wasting their time on them, unreasonably prescribing them medicines, as unworthy of treatment.

Note:sometimes it is necessary to transfer such patients to forced feeding.

Most patients experience muscle weakness, heaviness throughout the body, they move with great difficulty.

With a more compensated form of manic-depressive psychosis, patients independently look for the dirtiest work. Gradually, the ideas of self-accusation lead some patients to thoughts of suicide, which they can fully translate into reality.

Most pronounced in the morning, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, like to go under the bed, because they consider themselves unworthy of being in a normal position. They are reluctant to make contact, they respond monotonously, with a slowdown, without further ado.

On the faces there is an imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are lowered down, the eyes are dull, inactive.

Options for the depressive phase:

asthenic depression– patients with this type of manic-depressive psychosis are dominated by ideas of their own soullessness in relation to relatives, they consider themselves unworthy parents, husbands, wives, etc.
anxious depression- proceeds with the manifestation of an extreme degree of anxiety, fears, bringing patients to. In this state, patients may fall into a stupor.

In almost all patients in the depressive phase, the Protopopov triad occurs - palpitations, dilated pupils.

Symptoms of disordersmanic-depressive psychosisfrom the internal organs:

dry skin and mucous membranes;
lack of appetite;
in women, disorders of the monthly cycle.

In some cases, TIR is manifested by dominant complaints of persistent pain, discomfort in the body. Patients describe the most versatile complaints from almost all organs and parts of the body.

Note:some patients try to mitigate complaints to resort to alcohol.

The depressive phase can last 5-6 months. Patients are unable to work during this period.

Cyclothymia is a mild form of manic-depressive psychosis.

There are both a separate form of the disease and a lighter version of TIR.

Cyclotomy proceeds with phases:

How does TIR work?

There are three forms of the course of the disease:

circular- periodic alternation of phases of mania and depression with a light interval (intermission);
alternating- one phase is immediately replaced by another without a light gap;
unipolar- the same phases of depression or mania go in a row.

Note:usually phases last for 3-5 months, and light intervals can last several months or years.

Manic-depressive psychosis in different periods of life

In children, the onset of the disease may go unnoticed, especially if the manic phase dominates. Young patients look hyperactive, cheerful, playful, which does not immediately allow us to notice unhealthy traits in their behavior against the background of their peers.

In the case of the depressive phase, children are passive and constantly tired, complaining about their health. With these problems, they quickly get to the doctor.

In adolescence, the manic phase is dominated by symptoms of swagger, rudeness in relationships, and there is a disinhibition of instincts.

One of the features of manic-depressive psychosis in childhood and adolescence is the short duration of the phases (average 10-15 days). With age, their duration increases.

Treatment of manic-depressive psychosis

Therapeutic measures are built depending on the phase of the disease. Severe clinical symptoms and the presence of complaints require the treatment of manic-depressive psychosis in a hospital. Because, being depressed, patients can harm their health or commit suicide.

The difficulty of psychotherapeutic work lies in the fact that patients in the phase of depression practically do not make contact. An important point of treatment during this period is the correct selection antidepressants. The group of these drugs is diverse and the doctor prescribes them, guided by his own experience. Usually we are talking about tricyclic antidepressants.

With dominance in the status of lethargy, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.

In the absence of appetite, the treatment of manic-depressive psychosis is supplemented with restorative drugs

In the manic phase, antipsychotics with pronounced sedative properties are prescribed.

In the case of cyclothymia, it is preferable to use milder tranquilizers and antipsychotics in small dosages.

Note:quite recently, lithium salt preparations were prescribed in all phases of MDP treatment, at present this method is not used by all doctors.

After leaving the pathological phases, patients should be included in various activities as early as possible, this is very important for maintaining socialization.

Explanatory work is carried out with relatives of patients about the need to create a normal psychological climate at home; a patient with symptoms of manic-depressive psychosis during light intervals should not feel like an unhealthy person.

It should be noted that, in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence and performance without degradation.

Interesting! From a legal point of view, a crime committed in the TIR aggravation phase is considered not subject to criminal liability, and in the intermission phase - criminally punishable. Naturally, in any state suffering from psychosis are not subject to military service. In severe cases, disability is assigned.

Any person is prone to developing low or high mood. However, if a person does not have good reasons for this, the mood itself either falls or rises, the person cannot control the processes, then we can talk about a pathological change in mood - manic-depressive psychosis (or bipolar disorder). The causes lie in many areas of a person's life, the signs are divided into two variations of opposite phases that require treatment.

Often a person does not realize what is happening to him. He can only watch how his mood either becomes excitable or passive, sleep either quickly arises (drowsiness), then completely disappears (insomnia), that is, energy, then it is gone. Therefore, here only relatives are left to take the initiative in order to help a person recover from his illness. Although at first glance everything may appear normal, in fact the two phases - mania and depression - gradually progress and deepen.

If the manic-depressive disorder is not pronounced, then we are talking about cyclotomy.

What is manic-depressive psychosis?

Manic-depressive psychosis is a mental disorder in which a person experiences sudden mood swings. Moreover, these sentiments are opposite to each other. During the manic phase, a person experiences an increase in energy, an unmotivated cheerful mood. During the depressive phase, a person falls into a depressed state for no good reason.

In mild forms, manic-depressive disorder is not even noticed by a person. Such people are not hospitalized, they live among ordinary people. However, the danger may lie in the rash acts of the patient, who may commit an illegal violation in the phase of mania or commit suicide during depression.

Manic-depressive psychosis is not a disease that makes people sick. Everyone at least once in his life fell into a depressive state, then into an increased uplift. Because of this, a person cannot be called sick. However, in manic-depressive psychosis, mood swings seem to happen by themselves. Of course, there are external factors that contribute to this.

Experts say that a person should be genetically predisposed to sudden mood swings. However, this disorder may not manifest itself, unless external factors contribute to this:

Childbirth.
Parting with a loved one.
Loss of a job you love. etc.

Manic-depressive psychosis can be developed in a person through constant exposure to negative factors. You can become mentally abnormal if a person is constantly exposed to certain external circumstances or human influence, in which he is either in euphoria or falls into a depressive state.

Manic-depressive psychosis can manifest itself in various forms:

First there are two phases of mania with remission, and then depression sets in.
First comes, and then mania, after which the phases are repeated.
There are no periods of normal mood between interphases.
Between separate interphases there are remissions, and in other cases they are absent.
Psychosis can manifest itself in only one phase (depression or mania), and the second phase occurs for a short period of time, after which it quickly passes.

Causes of manic-depressive psychosis

While the specialists of the site of psychiatric help, the site cannot give a complete list of all the causes that cause manic-depressive psychosis. However, among the known factors are the following:

A genetic defect that is passed from parent to child. This cause explains 70-80% of all episodes.
Personal qualities. It is noted that manic-depressive disorder occurs in persons with a developed sense of responsibility, constancy and order.
Abuse of drugs and alcohol.
Copy of parent behavior. It is not necessary to be born into a family of mentally ill people. Manic-depressive psychosis may be the result of copying the behavior of parents who behave in one way or another.
Influence of stress and mental trauma.

The disease develops equally in men and women. Men are more likely to suffer from bipolar disorder, while women are more likely to suffer from unipolar disorder. Predisposing factors for the development of manic-depressive disorder in women are childbirth and pregnancy. If after giving birth within 2 weeks a woman has mental disorders, then the chance of bipolar psychosis increases by 4 times.

Signs of manic-depressive psychosis

Manic-depressive psychosis is characterized by signs that change dramatically in one phase or another. As noted above, the disease has several forms of its manifestation:

Unipolar (monopolar) depressive - when a person is faced with only one phase of psychosis - depression.
Monopolar manic - when a person experiences only a drop into the manic stage.
Distinctly bipolar disorder - when a person falls into a phase of mania, then into a phase of depression "according to all the rules" and without distortions.
Bipolar disorder with depression - when a person experiences both phases of the disease, but depression is predominant. The phase of mania in general can proceed sluggishly or not disturb the person.
Bipolar disorder with a predominance of mania - when a person stays in the manic phase more often and for a longer time, and the depressive stage proceeds easily and without much worries.

A correctly intermittent disease is called psychosis, where depression and mania replace each other, while between them there are periods of intermission - when a person returns to a normal emotional state. However, there is also an incorrectly intermittent disease, when after depression depression can come again, and after mania - mania, and only then the phase will switch to the opposite one.

Manic-depressive psychosis has its own symptoms of manifestation, which replace each other. One phase can last from a few months to a couple of years, and then move on to another phase. Moreover, the depressive phase differs in its duration than the manic one, and is also considered the most dangerous, since it is in a state of depression that a person cuts off all social ties, thinks about suicide, closes, and his performance decreases.

The manic phase is distinguished by the following symptoms:

In the first hypomanic stage:

Active verbose speech.
Increased appetite.
Distractibility.
Mood boost.
Some insomnia.
Cheerfulness.

At the stage of severe mania:

Strong verbal excitement.
Inability to concentrate, jumping from topic to topic.
Outbursts of anger, quickly fading away.
Minimum need for rest.
Motor excitement.
Megalomania.

During the manic rampage stage:

Random jerky movements.
Brilliance of all symptoms of mania.
Incoherent speech.

At the stage of motor sedation:

speech excitement.
Mood boost.
Decreased motor arousal.

Reactive stage:

Decreased mood in some cases.
Gradual return to normal.

It happens that the manic phase is marked only by the first (hypomanic) stage. In the depressive manifestation phase, the following stages of symptom development are noted:

At the initial stage:

Weakening of muscle tone.
Difficult to fall asleep.
Decreased performance.
Deterioration of mood.

At the stage of increasing depression:

Insomnia.
Slow speech.
Decreased mood.
Decreased appetite.
Significant deterioration in performance.
Inhibition of movements.

At the stage of severe depression:

Quiet and slow speech.
Refusal to eat.
Self-flagellation.
Feelings of anxiety and sadness.
Prolonged stay in one position.
Thoughts of suicide.
Monosyllabic answers.

At the reactive stage:

Decreased muscle tone.
Restoration of all functions.

A depressive state can be supplemented by vocal hallucinations that will convince a person of the hopelessness of his situation.

How to treat manic-depressive psychosis?

You can treat manic-depressive psychosis together with a doctor who first identifies the disorder and differentiates it from brain lesions. This can be done by undergoing radiography, electroencephalography, MRI of the brain.

Treatment of psychosis is carried out in a stationary mode in several directions at once:

Taking medications: antidepressants and sedatives (Levomepromazine, Chlorpromazine, Lithium salts, Haloperedol). You need medication to stabilize your mood.
The use of omega-3-polyunsaturated fatty acids, which help to improve mood and eliminate relapses. They are found in spinach, camelina, linseed and mustard oils, oily sea fish, seaweed.
Psychotherapy, in which a person is taught to control their emotional states. Family therapy is possible.
Transcranial magnetic stimulation - the impact on the brain with magnetic impulses of a non-invasive nature.

It is necessary to be treated not only at the moments of exacerbation of the phases, but also during the intermission - when a person feels good. If there are additional disorders, deterioration in health, then medications are prescribed to eliminate them.

Outcome

Manic depressive disorder can be considered a normal mood swing, when a person is in a good mood, then in a bad mood. Is it worth it to start taking medication because of this? It should be understood that each person experiences this state in his own way. There are people who have learned to manage their mood swings to the best of their ability.

For example, during the mania phase, a person usually starts to come up with a lot of ideas. He becomes very creative. If, in addition to words, you also make efforts, then you can create something new at the stage of a large amount of energy, transform your life.

During the depression stage, it is important to give yourself rest. Since a person feels the need to retire, you can use this time to think about your life, plan further actions, relax and gain strength.

Manic-depressive psychosis manifests itself in various forms. And here it is important not to become a hostage of your mood. Usually a person does not analyze what contributes to the appearance of his mood, but simply reacts and acts on emotions. However, if you understand your condition, then you can even take control of a pathological disorder.

Irritability, anxiety, may not just be the consequences of a hard work week or any setbacks in your personal life. It may not just be nerve problems, as many prefer to think. If a person for a long time without a significant reason feels mental discomfort and notices strange changes in behavior, then you should seek help from a qualified psychologist. Possibly psychosis.

Two concepts - one essence

In various sources and various medical literature on mental disorders, one can come across two concepts that at first glance may seem completely opposite in meaning. These are manic-depressive psychosis (MDP) and bipolar affective disorder (BAD). Despite the difference in definitions, they express the same thing, they talk about the same mental illness.

The fact is that from 1896 to 1993, a mental illness, expressed in a regular change of manic and depressive phases, was called manic-depressive disorder. In 1993, in connection with the revision of the International Classification of Diseases (ICD) by the world medical community, MDP was replaced by another abbreviation - BAR, which is currently used in psychiatry. This was done for two reasons. First, not always bipolar disorder is accompanied by psychosis. Secondly, the definition of TIR not only frightened the patients themselves, but also repelled other people from them.

Statistical data

Manic-depressive psychosis is a mental disorder that occurs in approximately 1.5% of the inhabitants of the Earth. Moreover, the bipolar type of the disease is more common in women, and the monopolar one in men. About 15% of patients treated in psychiatric hospitals suffer from manic-depressive psychosis.

In half of the cases, the disease is diagnosed in patients aged 25 to 44 years, in a third of cases - in patients older than 45 years, and in older people there is a shift towards the depressive phase. Quite rarely, the diagnosis of MDP is confirmed in persons under 20 years of age, since in this period of life a quick change of mood with a predominance of pessimistic tendencies is the norm, since the psyche of a teenager is in the process of formation.

TIR characteristic

Manic-depressive psychosis is a mental illness in which two phases - manic and depressive - alternate with each other. During the manic phase of the disorder, the patient experiences a huge surge of energy, he feels great, he seeks to direct the excess energy into the mainstream of new hobbies and hobbies.

The manic phase, which lasts quite a short time (about 3 times shorter than the depressive one), is followed by a "light" period (intermission) - a period of mental stability. During the period of intermission, the patient is no different from a mentally healthy person. However, the subsequent formation of the depressive phase of manic-depressive psychosis is inevitable, which is characterized by a depressed mood, a decrease in interest in everything that seemed attractive, a detachment from the outside world, and the emergence of suicidal thoughts.

Causes of the disease

As with many other mental illnesses, the causes and development of TIR are not fully understood. There are a number of studies proving that this disease is transmitted from mother to child. Therefore, the presence of certain genes and hereditary predisposition is important for the onset of the disease. Also, a significant role in the development of TIR is played by disruptions in the endocrine system, namely, an imbalance in the amount of hormones.

Often a similar imbalance occurs in women during menstruation, after childbirth, during menopause. That is why manic-depressive psychosis in women is observed more often than in men. Medical statistics also show that women diagnosed with depression after childbirth are more susceptible to the onset and development of TIR.

Among the possible reasons for the development of a mental disorder is the patient's personality itself, its key features. More than others, people with a melancholic or statothymic personality type are susceptible to the occurrence of TIR. Their distinguishing feature is a mobile psyche, which is expressed in hypersensitivity, anxiety, suspiciousness, fatigue, an unhealthy desire for orderliness, as well as solitude.

Diagnosis of the disorder

In most cases, bipolar manic-depressive disorder is extremely easy to confuse with other mental disorders, such as anxiety disorder or some types of depression. Therefore, it takes a psychiatrist some time to diagnose MDP with certainty. Observations and examinations continue at least until the patient has a clearly identified manic and depressive phase, mixed states.

The anamnesis is collected using tests for emotionality, anxiety and questionnaires. The conversation is conducted not only with the patient, but also with his relatives. The purpose of the conversation is to consider the clinical picture and the course of the disease. Differential diagnosis allows the patient to exclude mental illnesses that have symptoms and signs similar to manic-depressive psychosis (schizophrenia, neuroses and psychoses, other affective disorders).

Diagnostics also includes examinations such as ultrasound, MRI, tomography, various blood tests. They are necessary to exclude physical pathologies and other biological changes in the body that could provoke the occurrence of mental abnormalities. This, for example, is the malfunction of the endocrine system, cancerous tumors, and various infections.

Depressive phase of TIR

The depressive phase usually lasts longer than the manic phase and is characterized primarily by a triad of symptoms: depressed and pessimistic mood, slow thinking, and retardation of movement and speech. During the depressive phase, mood swings are often observed, from depressed in the morning to positive in the evening.

One of the main signs of manic-depressive psychosis during this phase is a sharp weight loss (up to 15 kg) due to lack of appetite - food seems bland and tasteless to the patient. Sleep is also disturbed - it becomes intermittent, superficial. The person may suffer from insomnia.

With an increase in depressive moods, the symptoms and negative manifestations of the disease intensify. In women, a sign of manic-depressive psychosis during this phase may even be a temporary cessation of menstruation. However, the aggravation of symptoms, rather, consists in slowing down the patient's speech and thought process. Words are hard to find and connect with each other. A person withdraws into himself, renounces the outside world and any contacts.

At the same time, the state of loneliness leads to the emergence of such a dangerous complex of symptoms of manic-depressive psychosis as apathy, longing, and extremely depressed mood. It can cause suicidal thoughts to form in the patient's head. During the depressive phase, a person diagnosed with TIR needs professional medical help and support from loved ones.

Manic phase TIR

Unlike the depressive phase, the triad of symptoms of the manic phase is directly opposite in nature. This is an elevated mood, violent mental activity and speed of movement, speech.

The manic phase begins with the patient feeling a surge of strength and energy, a desire to do something as soon as possible, to realize himself in something. At the same time, a person has new interests, hobbies, and the circle of acquaintances expands. One of the symptoms of manic-depressive psychosis in this phase is a feeling of overabundance of energy. The patient is infinitely cheerful and cheerful, does not need sleep (sleep can last 3-4 hours), makes optimistic plans for the future. During the manic phase, the patient temporarily forgets past grievances and failures, but remembers the names of films and books lost in memory, addresses and names, phone numbers. During the manic phase, the efficiency of short-term memory increases - a person remembers almost everything that happens to him at a given moment in time.

Despite the seemingly productive manifestations of the manic phase at first glance, they do not play into the hands of the patient at all. So, for example, a stormy desire to realize oneself in something new and an unbridled desire for vigorous activity usually does not end in something good. Patients in the manic phase rarely see things through. Moreover, hypertrophied self-confidence and good luck from the outside during this period can push a person to rash and dangerous actions for him. These are large bets in gambling, uncontrolled spending of financial resources, promiscuity, and even committing a crime for the sake of getting new sensations and emotions.

The negative manifestations of the manic phase are usually visible immediately to the naked eye. Symptoms and signs of manic-depressive psychosis in this phase also include extremely rapid speech with swallowing of words, energetic facial expressions and sweeping movements. Even preferences in clothes can change - it becomes more catchy, bright colors. During the climactic stage of the manic phase, the patient becomes unstable, excess energy turns into extreme aggressiveness and irritability. He is unable to communicate with other people, his speech may resemble the so-called verbal okroshka, as in schizophrenia, when sentences are divided into several logically unrelated parts.

Treatment of manic-depressive psychosis

The main goal of a psychiatrist in the treatment of a patient diagnosed with MDP is to achieve a period of stable remission. It is characterized by partial or almost complete relief of the symptoms of the underlying disorder. To achieve this goal, it is necessary both to use special preparations (pharmacotherapy) and to turn to special systems of psychological influence on the patient (psychotherapy). Depending on the severity of the disease, the treatment itself can take place both on an outpatient basis and in a hospital.

Pharmacotherapy.

Since manic-depressive psychosis is a rather serious mental disorder, its treatment is not possible without medication. The main and most frequently used group of drugs during the treatment of patients with bipolar disorder is a group of mood stabilizers, the main task of which is to stabilize the patient's mood. Normotimics are divided into several subgroups, among which those used for the most part in the form of salts stand out.

In addition to lithium preparations, the psychiatrist, depending on the patient's symptoms, may prescribe antiepileptic drugs that have a sedative effect. These are valproic acid, "Carbamazepine", "Lamotrigine". In the case of bipolar disorder, the use of mood stabilizers is always accompanied by neuroleptics, which have an antipsychotic effect. They inhibit the transmission of nerve impulses in those brain systems where dopamine serves as a neurotransmitter. Antipsychotics are used mainly during the manic phase.

It is rather problematic to treat patients in TIR without taking antidepressants in combination with mood stabilizers. They are used to alleviate the patient's condition during the depressive phase of manic-depressive psychosis in men and women. These psychotropic drugs, affecting the amount of serotonin and dopamine in the body, relieve emotional stress, preventing the development of melancholy and apathy.

Psychotherapy.

This type of psychological help, like psychotherapy, consists in regular meetings with the attending physician, during which the patient learns to live with his illness, like an ordinary person. Various trainings, group meetings with other patients suffering from a similar disorder help an individual not only to better understand his illness, but also to learn about special skills for controlling and stopping the negative symptoms of the disorder.

A special role in the process of psychotherapy is played by the principle of "family intervention", which consists in the leading role of the family in achieving the patient's psychological comfort. During treatment, it is extremely important to establish an atmosphere of comfort and tranquility at home, to avoid any quarrels and conflicts, as they harm the patient's psyche. His family and he himself must get used to the idea of the inevitability of manifestations of the disorder in the future and the inevitability of taking medications.

Forecast and life with TIR

Unfortunately, the prognosis of the disease in most cases is not favorable. In 90% of patients, after an outbreak of the first manifestations of MDP, affective episodes recur again. Moreover, almost half of the people suffering from this diagnosis for a long time go to disability. In almost a third of patients, the disorder is characterized by a transition from a manic phase to a depressive one, with no “bright gaps”.

Despite the seeming hopelessness of the future with a TIR diagnosis, it is quite possible for a person to live with him an ordinary normal life. The systematic use of normotimics and other psychotropic drugs allows you to delay the onset of the negative phase, increasing the duration of the "light period". The patient is able to work, learn new things, get involved in something, lead an active lifestyle, undergoing outpatient treatment from time to time.

Many famous personalities, actors, musicians and just people, one way or another connected with creativity, have been diagnosed with MDP. These are famous singers and actors of our time: Demi Lovato, Britney Spears, Jim Carrey, Jean-Claude Van Damme. Moreover, these are outstanding and world-famous artists, musicians, historical figures: Vincent van Gogh, Ludwig van Beethoven and, perhaps, even Napoleon Bonaparte himself. Thus, the diagnosis of TIR is not a sentence; it is quite possible not only to exist with it, but also to live with it.

General conclusion

Manic-depressive psychosis is a mental disorder in which depressive and manic phases replace each other, interspersed with the so-called light period - a period of remission. The manic phase is characterized by an excess of strength and energy in the patient, an unreasonably high spirits and an uncontrollable desire for action. The depressive phase, on the contrary, is characterized by a depressed mood, apathy, melancholy, retardation of speech and movements.

Women get MDP more often than men. This is due to disruptions in the endocrine system and a change in the amount of hormones in the body during menstruation, menopause, after childbirth. So, for example, one of the symptoms of manic-depressive psychosis in women is a temporary cessation of menstruation. Treatment of the disease is carried out in two ways: by taking psychotropic drugs and conducting psychotherapy. The prognosis of the disorder, unfortunately, is unfavorable: after the treatment, almost all patients may experience new affective seizures. However, with due attention to the problem, you can live a full and active life.

TIR is a serious mental illness caused by pathological physiological changes in the body, due only to internal factors, scientifically described in 1854 by French researchers as "circular psychosis" and "insanity in two forms." Its classic version is two pronounced phases of affect: mania (hypomania) and depression, and periods of relative health between them (interphases, intermissions).

The name manic-depressive psychosis has existed since 1896, and in 1993 it was recognized as traumatic and carrying some kind of illness scenario, and the correct one was recommended - bipolar affective disorder (BAD). The problem implies the presence of two poles, and, having one, bears the forced name: "bipolar disorder of the unipolar form."

Each of us can experience mood swings, periods of decline or causeless happiness. MDP is a pathological form with a long course of these periods, which are characterized by extreme polarity. In the case of a manic-depressive psychosis, no causes of joy can bring the patient out of depression, and negative things - from an inspired and joyful state (manic phase). Moreover, each stage can last a week, months or years, interspersed with periods of absolutely critical attitude towards oneself, with a complete restoration of personal qualities.

BAD is not diagnosed in childhood, often coexisting with hyperactivity, age-related crises or developmental delay, manifesting itself in adolescence. Often in childhood, the phase of mania passes as a manifesto of disobedience and denial of the norms of behavior.

It is revealed by age in an approximate ratio:

in adolescence - 16-25 years old, there is a high probability of depression, with a suicidal risk;
25-40 years old - the majority - about 50% of patients with TIR, up to 30 years old - bi- (i.e. depression plus mania) is more often characteristic, after - monopolarity (only one affective phase);
after 40-50 years - about 25% of diseases, course with an emphasis on depressive episodes.

It was found that the bipolarity of psychosis is more common in men, monopolarity - in women.

The risk group includes women who have experienced postpartum depression in their time, or this is a delayed first episode of the disease. There is also a connection between the first phases of the disease and the menstrual and menopausal periods.

Causes

The causes of manic-depressive psychosis are internal, non-somatic in nature (that is, not associated with diseases of the body). Non-hereditary genetic and neurochemical prerequisites are traced, possibly provoked by mechanical interventions and emotional stresses, and not necessarily traumatic. Often an episode of depression that looks random (isolated) is the first harbinger of the subsequent development of the clinical picture of MDP.

According to the latest data, people are equally susceptible to the disease, regardless of ethnic, social and gender affiliations. Until recently, women were thought to be at twice the risk of the disease.

According to psychiatry, 1 out of 2,000 people are subject to manic-depressive psychosis in Russia, which is 15% of the entire flow of mental patients. According to foreign statistics: up to 8 people out of a thousand are susceptible to the disease to one degree or another.

There is no single approach to the study of BAD, even in the classification there are different spectra with the identification of new types of pathology, as a result, there is no clarity of the boundaries of the diagnosis and difficulty in assessing the prevalence.

We can talk about the predisposition to bipolar disorder of people of a melancholic warehouse with emotional instability, with a fear of breaking the rules, responsible, conservative and conscientious. Manic-depressive pedantry can be observed with a brightly colored neurotic reaction to moments that are insignificant for the layman.

The complexity of answering the question of why people develop bipolar disorder is exacerbated by complex symptoms, the lack of a unified approach, and the human psyche will remain a mystery for a long time to come.

Clinical picture

The course of manic-depressive psychosis can take place according to different scenarios, differing in the frequency and saturation of periods of mania, depression and intermission, accompanied by mixed states.

Unipolarity:
- periodic mania;
- periodic depression. The most common type. Not all classifiers refer to MDS.
Correct-intermittent type - phases of depression replaces mania through periods of intermission. After unipolar depressions, it is the most characteristic of the currents of manic-depressive syndrome.
Irregularly intermittent type - a random change of phases, one can repeat again, with the observance of intermission.
Double view - phase change: mania-depression or depression-mania, interphase - between couples, not between.
Circular - change of periods of the disease without intermissions.

The duration of mania is usually from one and a half weeks to 4 months, depression - longer, mixed states occur.

Main symptoms

Symptoms of the manic phase

The course of manic-depressive psychosis often begins with a manic phase, characterized in general by an increase in mood, mental and motor activity.

Stages of mania:

Hypomania - erased mania: energy, increased mood, acceleration of the pace of speech, memory, attention, appetite, physical activity may improve, the need for sleep decreases.
Expressed mania - the patient does not listen to others, is distracted, a jump in ideas is possible, anger, communication is difficult. Speech and motor activity is intense and non-constructive. The emergence of crazy projects against the background of the realization of omnipotence. At this stage, sleep up to 3 hours.
Manic frenzy - extreme exacerbation of symptoms: disinhibited motor activity, speech unrelated, contains fragments of thoughts, communication is impossible.
Motor sedation is a symptom with the preservation of active speech activity and mood, the manifestations of which also gradually tend to normal.
Reactive - indicators come back to normal. Often there is amnesia of periods of stages of severe and fury.

The passage of the manic phase can be limited only by the first stage - hypomania.

The severity and severity of the stage is determined by the rating scale of Young's mania.

Symptoms of the depressive phase

In general, the depressive phase is more characteristic of the clinical picture of MDS. Depressed mood, inhibited thinking and physical activity, with morning exacerbation and positive dynamics in the evening.

Her stages:

Initial - a gradual decrease in activity, efficiency, vitality, fatigue appears, sleep becomes superficial.
Increasing - there is anxiety, physical and mental exhaustion, insomnia, a decrease in the rate of speech, loss of interest in food.
The stage of severe depression is an extreme expression of psychotic symptoms - depression, fear, anxiety, stupor, self-flagellation, delirium, anorexia, suicidal thoughts, voices - hallucinations are possible.
Reactive - the last stage of depression, the normalization of body functions. If it begins with the restoration of motor activity, with a persistent depressed mood, the risk of suicide is exacerbated.

Depression can be atypical, accompanied by drowsiness and increased appetite. Feelings of unreality of what is happening may appear, somatic signs may appear - gastrointestinal disorders and urination. After an attack of depression, signs of asthenia are observed for some time.

The degree of depression is measured by the Depression Self-Questionnaire and the Zang Scale.

What is dangerous manic-depressive psychosis

The diagnosis of manic-depressive psychosis includes mania, lasting about 4 months, which on average accounts for 6 months of depression, and during these periods the patient may fall out of life.

The aggravation phase is not only detrimental to those who suffer from this disorder.

In a state of mania, the patient, driven by uncontrollable feelings, often commits rash acts that lead to the most disastrous consequences - loans taken, trips to the other side of the world, loss of apartments, promiscuity.

In depression, a person, as a result of feelings of guilt, often after manias, and deconstructive behavior destroys established relationships, including family ones, and loses his ability to work. Suicidal tendencies are possible. At this time, surveys of control and patient care are acute.

Negative personality changes traumatize people forced to live with the patient during the crisis. The patient can cause irreparable harm to himself and loved ones in a state of passion.

The state of health of a person who has undergone a negative phase of the disease can last a lifetime, i.e., an exacerbation may not happen. But in this case, it is customary to talk about a long interphase, and not about a healthy person with an unpleasant episode in life.

A person prone to such conditions needs to be prepared for such manifestations of the disease, and at the first of its symptoms, take measures - begin treatment of manic-depressive psychosis or its correction.

In case of violation of the law, BAD as a mental illness is considered as a mitigating circumstance only when in the disease phase. During remission, the violator is called upon to answer according to the law.

Diagnostics

For the diagnosis of manic depressive psychosis, a differential method is used, considering the spectrum of neuropsychiatric diseases and not only: schizophrenia, oligophrenia, depression variants, neuroses, psychoses, social disorders, somatic diseases. Separating, among other things, symptoms provoked by alcohol or medical and narcotic drugs.

Screening and study of the severity of the phases takes place as a result of the use of questionnaires - self-assessment tests.

Treatment with a timely diagnosis is quite effective, especially given after (or during) the first phase of MDS. For a correct diagnosis, at least one period of manic (hypomanic) properties is needed; as a result, bipolar disorder is often diagnosed only 10 years after the first episode.

Difficulties in diagnosing the disorder are aggravated by the relativity of the pathology, the subjectivity of any questionnaires, the frequent concomitance of other mental problems, the individual course of the disease, and the inconsistency of research data. Research data cannot be objective due to the huge number of drugs that TIR patients are forced to take.

An erroneous diagnosis and improper medication can provoke a rapid change in cycles, shorten interphases or otherwise aggravate the course of the disease, and lead to disability.

Treatment and prevention

The goal of TIR treatment is to achieve intermission and normalize the psyche and health. During periods of prevention and in the state of the manic phase, normotimics are used - drugs that stabilize mood: lithium preparations, anticonvulsants, antipsychotics.

The effectiveness of drugs is individual, their combinations can be intolerable, provoke deterioration, antiphase or shortening of periods of health. Treatment of manic-depressive psychosis involves the constant intake of a combination of drugs, is prescribed and adjusted exclusively by a doctor and is under his close supervision.

Insulin therapy and electroshock, the side effect of which is memory loss, were widely used in the 20th century, are extremely unpopular, as inhumane, and are considered as a method of treatment in extreme cases when other means have not worked. Well, until 1900, depression was treated with heroin.

Psychotherapy

Manifestations of bipolar disorder can be smoothed out. Life values can temporarily change in the most drastic way, leaving behind a person only a lack of understanding of his behavior and regret about a specific life episode where he messed up firewood.

If such things are repeated and there are periods of depression, it's time to think: how to help yourself if you have bipolar affective disorder?

A visit to a psychiatrist is necessary, do not think that you will immediately be given a dangerous diagnosis. There is a presumption of mental health, but you and your loved ones may need help.

Psychotherapy will help you accept your diagnosis without feeling inferior, understand yourself and forgive mistakes. Thanks to drug support and psychotherapy, you can lead a full life, adjust your mental health, having studied the pitfalls of your illness.

Symptoms and treatment

What is manic-depressive psychosis? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Bachilo E.V., a psychiatrist with an experience of 9 years.

Definition of disease. Causes of the disease

Affective insanity- chronic disease of the affective sphere. This disorder is currently referred to as bipolar affective disorder (BAD). This disease significantly disrupts the social and professional functioning of a person, so patients need the help of specialists.

This disease is characterized by the presence of manic, depressive, and mixed episodes. However, during periods of remission (improvement of the course of the disease), the symptoms of the above indicated phases almost completely disappear. Such periods of absence of manifestations of the disease are called intermissions.

The prevalence of BAD is on average 1%. Also, according to some data, on average, 1 patient per 5-10 thousand people suffers from this disorder. The disease begins relatively late. The average age of patients with BAD is 35-40 years. Women get sick more often than men (approximately in a ratio of 3:2). However, it is worth noting that bipolar forms of the disease are more common at a young age (up to about 25 years), and unipolar (the occurrence of either manic or depressive psychosis) - at an older age (30 years). There are no exact data on the prevalence of the disorder in childhood.

The reasons for the development of BAD have not been precisely established to date. The most common genetic theory of the origin of the disease.

It is believed that the disease has a complex etiology. This is evidenced by the results of genetic, biological studies, the study of neuroendocrine structures, as well as a number of psychosocial theories. It was noted that in first-line relatives there is an "accumulation" of the number of cases of BAD and.

The disease can occur for no apparent reason or after any provoking factor (for example, after infectious, as well as mental illness associated with any psychological trauma).

An increased risk of developing bipolar disorder is associated with certain personality traits, which include:

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of manic-depressive psychosis

As noted above, the disease is characterized by phasicity. Bipolar disorder can manifest only as a manic phase, only as a depressive phase, or only as hypomanic manifestations. The number of phases, as well as their change, is individual for each patient. They can last from several weeks to 1.5-2 years. Intermissions ("light intervals") also have different durations: they can be quite short or last up to 3-7 years. The cessation of the attack leads to an almost complete restoration of mental well-being.

With BAD, there is no formation of a defect (as with), as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and change of phases.

Consider the main manifestations of bipolar affective disorder.

Depressive episode of bipolar disorder

The depressive phase is characterized by the following peculiarities:

the occurrence of endogenous depression, which is characterized by the biological nature of painful disorders involving not only mental, but also somatic, endocrine and general metabolic processes;
reduced mood background, slowing down of thinking and motor speech activity (depressive triad);
diurnal mood swings - worse in the morning (patients wake up in the morning with a feeling of melancholy, anxiety, indifference) and somewhat better in the evening (there is little activity);
loss of appetite, perversion of taste sensitivity (food seems to have "lost taste"), patients lose weight, menstruation may disappear in women;
possible psychomotor retardation;
the presence of longing, which is often felt as a physical feeling of heaviness behind the sternum (precordial longing);
decrease or complete suppression of libido and maternal instinct;
the occurrence of an “atypical variant” of depression is likely: appetite increases, hypersomnia occurs (wake intervals become shorter, and the sleep period is longer);
quite often there is a somatic triad (Protopopov's triad): tachycardia (rapid heartbeat), mydriasis (dilated pupil) and constipation;
the manifestation of various psychotic symptoms and syndromes - delusions (delusional ideas of sinfulness, impoverishment, self-accusation) and hallucinations (auditory hallucinations in the form of "voices" accusing or insulting the patient). The indicated symptoms may occur depending on the emotional state (mostly there is a feeling of guilt, sin, damage, impending disaster, etc.), while it is distinguished by a neutral theme (that is, it is incongruent with affect).

There are the following variants of the course of the depressive phase:

simple depression - manifested by the presence of a depressive triad and proceeds without hallucinations and delusions;
hypochondriacal depression - hypochondriacal delirium occurs, which has an affective coloring;
delusional depression - manifests itself in the form of "Cotard's syndrome", which includes depressive symptoms, anxiety, delusional experiences of nihilistic fantastic content, has a wide, grandiose scope;
agitated depression - accompanied by nervous excitement;
anesthetic depression (or "painful insensitivity") - the patient "loses" the ability to any feelings.

It should be noted separately that in bipolar disorder (especially in the depressive phase) there is a fairly high level of suicidal activity in patients. So, according to some data, the frequency of parasuicides in bipolar disorder is up to 25-50%. Suicidal tendencies (as well as suicidal intentions and attempts) are an important factor in determining the need for a patient to be admitted to a hospital.

Manic episode of BAD

Manic syndrome can have varying degrees of severity: from mild mania (hypomania) to severe with the manifestation of psychotic symptoms. With hypomania, there is an elevated mood, formal criticism of one's condition (or its absence), and there is no pronounced social maladaptation. In some cases, hypomania can be productive for the patient.

A manic episode is characterized by: symptoms:

the presence of a manic triad (increased mood background, acceleration of thinking, increased speech motor activity), opposite to the triad of a depressive syndrome.
patients become active, feel “a strong surge of energy”, everything seems to be “on the shoulder”, they start a lot of things at the same time, but do not finish them, productivity approaches zero, they often switch during a conversation, they cannot focus on something one, it is possible to constantly change from loud laughter to screaming, and vice versa;
thinking is accelerated, which is expressed in the emergence of a large number of thoughts (associations) per unit of time, patients sometimes “do not keep up” with their thoughts.

There are different types of mania. For example, the manic triad described above occurs in classic (happy) mania. Such patients are characterized by excessive cheerfulness, increased distractibility, superficiality of judgments, and unjustified optimism. Speech is slurred, sometimes to the point of complete incoherence.

Mixed BAR episode

This episode is characterized by the coexistence of manic (or hypomanic) and depressive symptoms that last at least two weeks or rather quickly (in a matter of hours) replace each other. It should be noted that the patient's disorders can be significantly expressed, which can lead to professional and social maladaptation.

The following manifestations of a mixed episode occur:

suicidal thoughts;
appetite disorders;
the various psychotic traits that are listed above;

Mixed states of BAR can proceed in different ways:

The pathogenesis of manic-depressive psychosis

Despite a large number of studies on bipolar disorder, the pathogenesis of this disorder is not completely clear. There are a large number of theories and hypotheses of the origin of the disease. To date, it is known that the occurrence of depression is associated with a violation of the exchange of a number of monoamines and biorhythms (sleep-wake cycles), as well as with dysfunction of the inhibitory systems of the cerebral cortex. Among other things, there is evidence of the participation of norepinephrine, serotonin, dopamine, acetylcholine and GABA in the pathogenesis of the development of depressive states.

The causes of the manic phases of BAD lie in the increased tone of the sympathetic nervous system, hyperfunction of the thyroid gland and pituitary gland.

In the figure below, you can see the cardinal difference in brain activity during the manic (A) and depressive (B) phases of bipolar disorder. Light (white) zones indicate the most active parts of the brain, and blue, respectively, vice versa.

Classification and stages of development of manic-depressive psychosis

Currently, there are several types of bipolar affective disorder:

bipolar course - in the structure of the disease there are manic and depressive phases, between which there are "bright gaps" (intermissions);
monopolar (unipolar) course - either manic or depressive phases occur in the structure of the disease. The most common type of flow occurs when only a pronounced depressive phase is present;
continual - phases succeed each other without periods of intermission.

Also, according to the DSM (American Classification of Mental Disorders) classification, there are:

Complications of manic-depressive psychosis

Lack of necessary treatment can lead to dangerous consequences:

Diagnosis of manic-depressive psychosis

The above symptoms are diagnostically significant in making a diagnosis.

Diagnosis of BAD is carried out according to the Tenth Revision of the International Classification of Diseases (ICD-10). So, according to ICD-10, the following diagnostic units are distinguished:

bipolar disorder with a current episode of hypomania;
bipolar disorder with a current episode of mania but no psychotic symptoms;
bipolar disorder with a current episode of mania and psychotic symptoms;
bipolar disorder with a current episode of mild or moderate depression;
bipolar disorder with a current episode of major depression but no psychotic symptoms;
bipolar disorder with a current episode of severe depression with psychotic symptoms;
BAR with a current mixed episode;
bipolar disorder in current remission;
Other BARs;
BAR, unspecified.

At the same time, it is necessary to take into account a number of clinical signs that may indicate a bipolar affective disorder:

the presence of any organic pathology of the central nervous system (tumors, previous injuries or operations on the brain, etc.);
the presence of pathology of the endocrine system;
substance abuse;
the absence of clearly defined full-fledged intermissions / remissions throughout the course of the disease;
lack of criticism of the transferred state during periods of remission.

Bipolar affective disorder must be distinguished from a range of conditions. If there are psychotic disorders in the structure of the disease, it is necessary to separate bipolar disorder from schizophrenia and schizoaffective disorders. Type II bipolar disorder must be distinguished from recurrent depression. You should also differentiate BAD from personality disorders, as well as various addictions. If the disease developed in adolescence, it is necessary to separate bipolar disorder from hyperkinetic disorders. If the disease developed at a later age - with affective disorders that are associated with organic diseases of the brain.

Treatment of manic-depressive psychosis

Bipolar affective disorder should be treated by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.

cupping therapy - aimed at eliminating existing symptoms and minimizing side effects;
maintenance therapy - preserves the effect obtained at the stage of stopping the disease;
anti-relapse therapy - prevents relapses (appearance of affective phases).

For the treatment of bipolar disorder, drugs from different groups are used: lithium preparations, antiepileptic drugs ( valproates, carbamazepine, lamotrigine), neuroleptics ( quetiapine, olanzapine), antidepressants and tranquilizers.

It should be noted that BAD therapy is carried out for a long time - from six months or more.

Psychosocial support and psychotherapeutic measures can significantly help in the treatment of bipolar disorder. However, they cannot replace drug therapy. To date, there are specially developed techniques for the treatment of ARBs that can reduce interpersonal conflicts, as well as somewhat “smooth out” cyclical changes in various environmental factors (for example, daylight hours, etc.).

Various psychoeducational programs are carried out in order to increase the patient's awareness of the disease, its nature, course, prognosis, as well as modern methods of therapy. This helps to establish a better relationship between the doctor and the patient, adherence to the therapy regimen, etc. In some institutions, various psychoeducational seminars are held, at which the above issues are discussed in detail.

There are studies and observations showing the effectiveness of the use of cognitive-behavioral psychotherapy in conjunction with drug treatment. Individual, group or family forms of psychotherapy are used to reduce the risk of relapse.

Today there are cards for self-registration of mood swings, as well as a self-control sheet. These forms help to quickly track changes in mood and timely adjust therapy and consult a doctor.

Separately, it should be said about the development of BAD during pregnancy. This disorder is not an absolute contraindication for pregnancy and childbirth. The most dangerous is the postpartum period, in which various symptoms can develop. The question of the use of drug therapy during pregnancy is decided individually in each case. It is necessary to evaluate the risk/benefit of the use of drugs, carefully weigh the pros and cons. Also, psychotherapeutic support for pregnant women can help in the treatment of ARBs. If possible, drugs should be avoided during the first trimester of pregnancy.

Forecast. Prevention

The prognosis of bipolar affective disorder depends on the type of course of the disease, the frequency of phase changes, the severity of psychotic symptoms, as well as the patient's adherence to therapy and control of his condition. So, in the case of well-chosen therapy and the use of additional psychosocial methods, it is possible to achieve long-term intermissions, patients adapt well socially and professionally.